□□□□-□□□□-□□□□-□□□□
Three yards of the end of the back of the card卡片背面末三碼 □□□

Expiration date
有效期限

□□MONTH月／ □□YEAR年

Date日期

____/____/____

Total
消費金額

US$

Credit card type
信用卡種類

□ VISA □ MASTER
□DISCOVERY

Signature of cardholder
(Subject to the same credit card)
持卡人簽名
(需與信用卡相同)

Transaction details
交易明細

Note:
(1)Before signing, please confirm the card number, is fill in the correct amount of consumption.
(2) since the end of retention in order to query the reconciliation.
(3)Cardholder should use conventions in accordance with the credit card, a signed shall be deemed to agree to pay the full amount indicated in the card-issuing bank
I understand the above provisions of instructions.
注意事項：